Selection of digestive tract reconstruction and analysis of inflammatory stress response in gastric cancer patients undergoing laparoscopic radical gastrectomy
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摘要: [目的]探讨腹腔镜胃癌远端根治术的消化道重建方式选择及炎性应激反应。[方法]选取78例行腹腔镜根治术的胃癌患者, 按照消化道重建方式的不同, 分为A组 (30例, 采用改良Roux-en-Y吻合术)、B组 (26例, 采用毕Ⅰ式吻合术)、C组 (22例, 采用毕Ⅱ式吻合术)。比较3组术中指标 (手术时间、消化道重建时间、术中出血量)、术后指标 (造影剂胃排空时间、排气时间、进流食时间、住院时间)、并发症发生率及炎性应激指标[白细胞介素-6 (IL-6)、C反应蛋白 (CRP)、一氧化氮 (NO)]的差异。[结果]A组手术时间、消化道重建时间、术中出血量均显著高于B组、C组 (均P<0.05)。A组碱性反流性胃炎及吻合口炎发生率均低于B组和C组 (均P<0.05)。治疗后3组患者IL-6、CRP、NO均高于治疗前 (均P<0.05), 且A组患者上述指标水平均低于B组、C组 (均P<0.05)。[结论]改良Roux-en-Y吻合术尽管手术时间较长、术中出血量较高、操作较复杂, 但能有效降低术后反流性食管炎及吻合口炎的发生率, 并且对机体造成的炎性应激反应程度低于毕Ⅰ式和毕Ⅱ式吻合术, 是较理想的远端胃癌根治术后消化道重建方式。Abstract: [Objective]To investigate the selection of digestive tract reconstruction and analysis of inflammatory stress response in gastric cancer patients undergoing laparoscopic radical gastrectomy.[Methods]76 patients with gastric cancer who underwent laparoscopic radical gastrectomy were selected, and they were divided into group A (30 cases with modified Roux-en-Y anastomosis) and group B (26 cases with Billroth Ⅰ anastomosis), group C (22 cases with Billroth Ⅱ anastomosis).Intraoperative indexes (operative time, gastrointestinal reconstruction time, intraoperative blood loss), postoperative indexes (contrast gastric emptying time, exhaust time, fluid food intake time, hospitalization time), complication rate and inflammatory stress indicators (IL-6, CRP, NO) of the three groups were compared.[Results]The operation time, gastrointestinal reconstruction time and intraoperative blood loss of group A were significantly higher than those of group B and group C (all P<0.05).The incidence of alkaline reflux gastritis and anastomotic stomatitis in group A was lower than those in group B and group C (all P<0.05).After treatment, IL-6, CRP and NO in the three groups were higher than those before treatment (P<0.05), and the above indicators in group A were lower than those in group B and group C (all P<0.05).[Conclusion]Although the modified Roux-en-Y anastomosis has a longer operation time, higher intraoperative blood loss and more complicated operation, it can effectively reduce the incidence of postoperative reflux esophagitis and anastomotic stomatitis, moreover, the degree of inflammatory stress response to the body is lower than of Billroth Ⅰ and Billroth Ⅱ anastomosis, which is an ideal method for reconstruction of digestive tract after radical resection of distal gastric cancer.
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